Relative biological effectiveness of proton beams in clinical therapy

Gerweck, Leo E.; Kozin, Sergey V.

doi:10.1016/s0167-8140(98)00092-9

Cited by 191 publications

(127 citation statements)

References 28 publications

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“…For proton dose distributions in a patient, LET d values can be up to six times larger than in a therapeutic x-ray beam (110 MeV protons with LET d 12 keV μm −1 (Grassberger et al 2011) compared to electrons with LET d 2 keV μm −1 produced from 10 MV photons (Amols and Kliauga 1985)). Recent results show considerable variations of LET d values within the irradiated volume in proton therapy (Grassberger et al 2011), which in combination with findings on a dependence of RBE with tissue type (Gerweck and Kozin 1999) could imply a departure of RBE from the average value of 1.1 for certain tissues or treatment scenarios. Also, with the current tendency toward hypofractionated regimens in particle radiotherapy the application of a generic RBE for all treatments might have to be revisited, especially since there is very limited data from hypofractionated proton treatments.…”

Section: Introductionmentioning

confidence: 77%

“…In particular, the larger the range the lower the LET d values observed at any depth within the beam, and the larger the width of the SOBP, the lower the LET d at the center of the SOBP. This complicates the interpretation of the data used to establish the relationship between proton RBE and (α/β) x (Gerweck and Kozin 1999) (Jones et al 2011). According to a previous study the uncertainty in (α/β) x translates into the uncertainty of RBE max and RBE min (Carabe et al 2012):…”

Section: Methodsmentioning

confidence: 99%

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Clinical consequences of relative biological effectiveness variations in proton radiotherapy of the prostate, brain and liver

et al. 2013

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Proton relative biological effectiveness (RBE) is known to depend on the (α/β) x of irradiated tissues, with evidence of ∼60% variation over (α/β) x values from 1-10 Gy. The range of (α/β) x values reported for prostate tumors (1.2-5.0 Gy), brain tumors (10-15 Gy) and liver tumors (13-17 Gy) imply that the proton RBE for these tissues could vary significantly compared to the commonly used generic value of 1.1. Our aim is to evaluate the impact of this uncertainty on the proton dose in Gy(RBE) absorbed in normal and tumor tissues. This evaluation was performed for standard and hypofractionated regimens. RBE-weighted total dose (RWTD) distributions for 15 patients (five prostate tumors, five brain tumors and five liver tumors) were calculated using an in-house developed RBE model as a function of dose, dose-averaged linear energy transfer (LET d ) and (α/β) x . Variations of the dose-volume histograms (DVHs) for the gross tumor volume (GTV) and the organs at risk due to changes of (α/β) x and fractionation regimen were calculated and the RWTD received by 10% and 90% of the organ volume reported. The goodness of the plan, bearing the uncertainties, was then evaluated compared to the delivered plan, which considers a constant RBE of 1.1. For standard fractionated regimens, the prostate tumors, liver tumors and all critical structures in the brain showed typically larger RBE values than 1.1. However, in hypofractionated regimens lower values of RBE than 1.1 were observed in most cases. Based on DVH analysis we found that the RBE variations were clinically significant in particular for the prostate GTV and the critical structures in the brain. Despite the uncertainties in the biological input parameters when estimating RBE values, the results show that the use of a variable RBE with dose, LET d and (α/β) x could help to further optimize the target dose in proton treatment

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Section: Introductionmentioning

confidence: 77%

Section: Methodsmentioning

confidence: 99%

Clinical consequences of relative biological effectiveness variations in proton radiotherapy of the prostate, brain and liver

et al. 2013

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“…This means that a physical dose of 1 Gy delivered using a proton beam is considered biologically equivalent to 1.1 Gy delivered using a photon beam. The assignment of relative biological effectiveness (RBE) is dependent on a number of biological endpoints which are often unpredictable (23,24). Because of this unpredictability and the aforementioned issue of range uncertainty, beam arrangements are often selected so that they do not stop directly in front of critical organs or structures.…”

Section: Hcc Radiation Treatment Planning With Proton Therapymentioning

confidence: 99%

Proton therapy for hepatocellular carcinoma

Ling

Kang

Bush

et al. 2012

Chin. J. Cancer Res.

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Proton radiotherapy has seen an increasing role in the treatment of hepatocellular carcinoma (HCC). Historically, external beam radiotherapy has played a very limited role in HCC due to a high incidence of toxicity to surrounding normal structures. The ability to deliver a high dose of radiation to the tumor is a key factor in improving outcomes in HCC. Advances in photon radiotherapy have improved dose conformity and allowed dose escalation to the tumor. However, despite these advances there is still a large volume of normal liver that receives a considerable radiation dose during treatment. Proton beams do not have an exit dose along the beam path once they enter the body. The inherent physical attributes of proton radiotherapy offer a way to maximize tumor control via dose escalation while avoiding excessive radiation to the remaining liver, thus increasing biological effectiveness. In this review we discuss the physical attributes and rationale for proton radiotherapy in HCC. We also review recent literature regarding clinical outcomes of using proton radiotherapy for the treatment of HCC.

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“…The majority of these studies conclude that late effects induced by protons or helium ions are nearly equivalent to what one would expect from equivalent photon doses. Proton RBE values are 1.0, except near the very end of the stopping Bragg peak [10,11,13,44,53,86,87] In conclusion, there is strong evidence supporting the use of proton radiotherapy as superior even to IMRT [40] and perhaps even as a replacement for external beam radiation therapy [106].…”

Section: Proton and Helium Radiation Therapymentioning

confidence: 99%

Late effects from hadron therapy

Blakely

Chang

2004

Radiotherapy and Oncology

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Successful cancer patient survival and local tumor control from hadron radiotherapy warrant a discussion of potential secondary late effects from the radiation. The study of late-appearing clinical effects from particle beams of protons, carbon, or heavier ions is a relatively new field with few data. However, new clinical information is available from pioneer hadron radiotherapy programs in the USA, Japan, Germany and Switzerland. This paper will review available data on late tissue effects from particle radiation exposures, and discuss its importance to the future of hadron therapy.Potential late radiation effects are associated with irradiated normal tissue volumes at risk that in many cases can be reduced with hadron therapy. However, normal tissues present within hadron treatment volumes can demonstrate enhanced responses compared to conventional modes of therapy. Late endpoints of concern include induction of secondary cancers, cataract, fibrosis, neurodegeneration, vascular damage, and immunological, endocrine and hereditary effects. Low-dose tissue effects at tumor margins need further study, and there is need for more acute molecular studies underlying late effects of hadron therapy.2

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Relative biological effectiveness of proton beams in clinical therapy

Cited by 191 publications

References 28 publications

Clinical consequences of relative biological effectiveness variations in proton radiotherapy of the prostate, brain and liver

Clinical consequences of relative biological effectiveness variations in proton radiotherapy of the prostate, brain and liver

Proton therapy for hepatocellular carcinoma

Late effects from hadron therapy

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